VN013 ATTORNEY OF PARTY WITHOUT ATTORNEY (Name and Address) Telephone Number FOR COURT USE ONLY E-MAIL ADDRESS ATTORNEY FOR (Name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF VENTURA 800 SOUTH VICTORIA AVE. VENTURA, CA 93009 IN THE MATTER OF THE APPLICATION OF FOR A CERTIFICATION OF REHABILITATION CERTIFICATE OF REHABILITATION No: _____________________________ CII No: _____________________________ DOB ____________________ The Petition of : (Name) ____________________________________________________________________________ Presently residing at (address) ______________________________________________________________________ Heretofore filed, praying for a Certificate of Rehabilitation pursuant to the provisions of Chapter 3.5, Title 6 or Part 3 of the Penal Code of the State of California came on regularly for hearing on ___________________________ and proof having been made to the satisfaction of the Court that notice of the time of hearing has been regularly given as required by law; and from satisfactory proof taken at said hearing the Court finds that all allegations of said petition are true, and that the required period of rehabilitation has elapsed since petitioner’s date of discharge from custody due to his completion of the term to which he was sentenced, or upon his release on parole or probation on (date) _____________________________________________, that where appropriate, petitioner has obtained relief pursuant to Penal Code section 1203.4, and that petitioner has demonstrated by his course of conduct his rehabilitation and fitness to exercise all civil and political rights of citizenship (except as provided in Penal Code section 4852.15); and that petitioner once has been twice thrice convicted of a felony: WHEREFORE, it is Ordered, Adjudged and Decreed, and this Court does hereby order, adjudge and decree that petitioner has been rehabilitated and is fit to exercise all the civil and political rights of citizenship (except as provided in Penal Code Section 4852.15), and by virtue thereof this court recommends that the Governor of the State of California grant a full pardon to said petitioner. Done in open court this date: ______________________ _____________________________________________ Judicial Officer This form prepared under the direction of the office of the Attorney General of the State of California Optional Form VN013 (Rev. 07/12) CERTIFICATE OF REHABILITATION American LegalNet, Inc. www.FormsWorkFlow.com